OSHA Publishes Resources to Assist Employers with Mental Health & Wellness
The United States Department of Labor Occupational Safety & Health Administration has posted numerous resources and tools for employers to utilize to combat workplace stress. OSHA has published these resources following a survey conducted by the American Psychological Association in 2021 that reported burnout and stress at an all-time high across all professions and that “actions from their employers would help their mental health.”
The resources published by OSHA include:
Employers are starting to recognize the impacts that worker mental health has in the workplace. Statistics cited by OSHA reveal that workplace stress has been reported to cause 120,000 deaths in the U.S. each year. Nearly 83% of workers suffer from work-related stress and more than half of those report that workplace stress impacts their home life. Importantly, for every $1.00 spent on ordinary mental health concerns, employers see a $4.00 return in productivity gains.
The American Psychological Association encourages employers to develop mental health and wellness programs in the workplace. They recommend that employers go beyond simply offering an Employee Assistance Program (EAP). They recommend a cross-departmental review of your company’s EAP offerings to assess if they are meeting your workforce needs. Also, ensure that your program includes mental health professionals from diverse backgrounds and specialties. Additionally, they encourage launching a communications campaign about the things that your EAP professionals can cover, including stress, mental health, and financial guidance. Most importantly, ensure that your frontline leaders are informed and able to communicate the EAP availability and offerings to your team.
Under the Mental Health Parity and Addiction Equity Act (MHPAEA), all employers sponsored health plans are required to offer the same level of health coverage for mental health-related concerns as for any other medical concerns. Most short- and long-term disability insurance plans offer a limited number of free Employee Assistance Plan visits as part of the included benefits. Lastly, American Ambulance Association members get free access to the Counselor Match Program, which provides access to mental health counselors with extensive experience in working with EMS and public safety professionals.
If you need assistance with this, or any other workplace challenges, please contact the AAA at firstname.lastname@example.org.
Results from AAA/Newton 360 Fourth Annual EMS Industry Turnover Study Shows Worsening Employee Turnover
The American Ambulance Association (AAA) and Newton 360, an Emergency Medical Services (EMS)-based workforce management software platform, joined forces again this year to conduct the fourth annual survey of employee turnover in the EMS industry. The 2022 survey presents turnover data from 119 EMS organizations, representing more than 12,000 employees. This year, the survey included data regarding the percentage of positions reported to be open at the time of the survey, which showed that EMS agencies are having difficulty filling open positions.
Over the last few years, EMS organizations were impressive in meeting the challenges in the face of the continuing COVID-19 global pandemic. The EMS workforce rose to the challenge and battled the disease, despite the workforce shortages that have plagued the EMS profession and other healthcare partners for nearly a decade. EMS organizations have offered innovative solutions to public health crises, including establishing testing and vaccinations sites around the country, suggesting that EMS employers and employees are prepared to expand their role to include greater provision of preventive services and community-based healthcare.
Turnover Rates by Year by Occupational Category
(2021 Results Appear in Parentheses Below the 2022 Results)
|Average Turnover for the Year 2021||Percentage of Open Positions Summer of 2022|
|Occupation||Overall Turnover||Voluntary Turnover||Involuntary Turnover||Open Rate|
Voluntary and overall turnover increased for 2022, with the turnover rate being in the 20 to 36 percent range for EMTs and Paramedics, a 6% increase over the prior year. Meaning that EMS agencies are experiencing a full turnover of all staff every 3-4 years. Greater than one third of all new hires, turnover within their first year of employment. Not surprisingly, this converted into a relatively high rate of currently open positions, especially for EMTs and Paramedics at EMS agencies around the country.
In keeping with prior year’s surveys, the primary reasons for cited for turnover across all positions within EMS agencies is low pay and benefits, followed by a change in career. While many agencies offered stipends and increase wages in an effort to incentivize employees, it has not flattened the turnover curve. One of the key findings in this year’s survey is the significant increase in open positions for those EMTS and Paramedics working in a part time capacity. The open position rate for part-time paramedics was at a staggering 55%, suggesting that those who previously worked EMS as a second job no longer find it an attractive part time career choice.
This study evidences a need to embark upon a larger initiative to collect data on the EMS workforce in the U.S. A report published by the Health Resources and Services Administration (HRSA) stated that there will be a need for an additional 40,000 EMS personnel by 2030, in part, because of the recognition of the valuable education, training, and experience individuals working in the EMS field offer in other healthcare settings. This will necessitate an extensive understanding of the nature and reasons for turnover in EMS-related occupations.
EEOC Issued New Guidance on Employer Mandatory COVID-19 Testing Policies
On July 12, 2022, the Equal Employment Opportunity Commission (EEOC) updated its guidance, What
You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws, which
impacted several long-standing COVID-19-related policies. The most significant policy change in the
latest guidance was related to employer mandatory COVID-19 testing. The updated guidance is not likely
to significantly impact EMS employer testing practices for field personnel, but could for those who work
in administrative or non-patient facing roles.
In the latest guidance, the EEOC changed its previous position that employers could generally require
COVID-19 testing for most employees. The EEOC had previously taken the position that it believed that
COVID-19 viral testing was per se, job-related and consistent with business necessity, regardless of the
employer type. Under the latest guidance, the EEOC is now stating that employers will need to more
closely analyze whether viral testing is job-related and consistent with business necessities. In doing so,
employers should utilize any of these factors:
The Center for Disease Control (CDC) level of community transmission.
The vaccination status of employees.
The degree of breakthrough infections are possible for vaccinated workers.
The transmissibility of current variants.
The possible severity of illness from a current variant.
In most instances, EMS employers who require COVID-19 viral testing for field employees for ongoing,
symptomatic, or return to work reasons, are likely to meet the job related and consistent with business
necessity requirement. However, for those employees who are in non-patient-facing roles, it will be far
more difficult to justify mandatory COVID-19 testing and employers should reconsider their position on
The guidance also included updates to clarify the timeline factors to consider when handling reasonable
accommodation exceptions for vaccinations and how there could be a reasonable pandemic-related
delay. However, they acknowledged that this is likely less impactful at this point in the pandemic.
Additionally, the guidance highlighted that employers are not under an obligation to engage an
employee who has a serious health condition if the employee has not requested an accommodation
Many EMS employers are currently required to mandate COVID-19 vaccinations for employees who may
enter or interact with the patients or staff of a covered healthcare facility unless they have a covered
religious or disability-related exemption. After nearly two years of the pandemic and the availability of
COVID-19 vaccinations, those employees who wish to be vaccinated would have done so by now. Those
who remain unvaccinated are doing so by choice.
If you have any questions or concerns regarding the updated guidance or any COVID-19 related
workplace practice, be sure to contact the American Ambulance Association for assistance at
The American Ambulance Association is partnering with Newton 360, an ambulance industry partner and Human Resource support firm, to conduct our fourth annual industry turnover study. Our intent is to comprehensively collect and analyze ambulance industry employee turnover data so as to produce a report that provides useful and actionable data. We are inviting EMS organizations to participate in the study. The study will be conducted and managed by Dennis Doverspike, PhD, and Rosanna Miguel, PhD, who are associated with the Center for Applied Talent Analytics at John Carroll University. Each individual or organizational response will be strictly confidential.
The purpose of the study is to better quantify and understand the reasons for turnover at nearly every organizational level within the EMS Industry. Thank you very much for your time and support.
Why participate in the survey?
It is recommended you gather information about your employees and about turnover before completing the questionnaire.
In this survey, we will be asking about headcount (filled and open positions), number of employees leaving the organization, and reasons for employees leaving. We will be asking these questions for each of the following job categories: supervisor, dispatch, EMT, part-time EMT, paramedic, and part-time paramedic. Headcount refers to the number of filled and open positions for each job category at the end of 2021. Filled positions refer to the number of employees in each job category that were on payroll at the end of 2021. For each job category, the number of filled positions should be added to the number of open positions at the end of 2021 to determine the total headcount.
The survey can be accessed by following the link below. It will open on July 5th, 2022, and close at end of day, July 15th, 2022.
Scott Moore, Esq.
Workforce Dynamics, Inc.
(781) 236-4411 office
(781) 771-9914 cellular
In my early EMS leadership career, I worked for an organization that was swallowed up by a large national EMS consolidator. The unsettled times that occurred during, and immediately following the acquisition, led a small group of paramedics to petition for union representation. At the time, I had not yet finished my undergraduate or law degree. My experience with leading a management team through a union campaign was non-existent. The organization hired a labor attorney to work with our team to ensure that we stayed compliant in the weeks leading up to the National Labor Relations Board (NLRB) election.
It was an incredibly difficult time for both the leadership and the employees. Anyone who has lived through a union campaign can tell you, it can make you question the type of leader and manager you think you are. It puts an unbelievable strain upon everyone in the organization. Ultimately, the employees elected not to be represented by a union. As a team, we learned a great deal during this process. We realized that we were not the employee-centric organization that we believed we were. There is an old saying in labor relations, “every company gets the union it deserves.”
Union representation had been on the decline for several decades as numerous laws and regulations have been enacted to address many of the concerns that drove union membership. As we know, the last few years have presented incredible challenges for EMS organizations and their employees. The Biden Administration brings with it a President who has adopted a pro-union agenda and a Secretary of Labor, who is a former union leader.
A recent article published by the National Law Review states that union petitions are up 57%. Nearly every day there is a story of unionization at organizations that were previously not union strongholds. Additionally, polling seems to suggest that Americans view unions far more favorably than they did just over a decade ago. Traditionally, unions used to focus on larger employers, but have recently added all employers, including those with smaller collective bargaining units.
EMS agencies are no exception to this trend in union representation. It should be no surprise to EMS leaders that several unions believe that EMS is ripe for labor organizing. I will not go into all of the reasons that EMS is the focus of labor organizations but suffice it to say, the recent workforce challenges have made their message far more enticing to employees. Recently, an organization that I once was a part of and would not have believed was ripe for organizing, just overwhelmingly voted to be represented by a union.
The Best Strategy
If your organization is committed to remaining in a non-union environment, it is critical that you make this an intentional part of your strategic plan. Generally, employees join unions because they are unhappy or dissatisfied with the relationship they have with the management team or company they work for. This is often articulated by dissatisfaction with pay and benefits, consistency in policy and procedure practices, and the day-to-day interactions with management. More specifically, the relationship or treatment by their immediate supervisor.
The best strategy is to be proactive. This is not something that employers can or should ignore. This must be a stated and intentional part of your organizational strategic plan. Due to the workforce shortage, most organizations have been evaluating their pay and benefits programs. However, we are not always so good at communicating these benefits to our employees. Often, we treat pay and benefits like trade secrets, even with our own folks. EMS is notorious for its rumor mill and it is far better to control or influence the narrative regarding the benefits that your employees enjoy by working for your organization. You will be surprised how many on your team have no idea that some of your benefits exist or are available to them.
Education and communication are key elements in any union-free workplace strategy. Employers should utilize the AAA Total Compensation Statement that highlights all costs associated with pay and benefits.
The leadership team should evaluate the frequency of supervisor-employee interactions and the tools used to track these engagements. The stronger the relationship between the frontline employees and the leadership team, the less likely your employees are to invite an outside third party to represent them. If this is not one of your organization’s leading Key Performance Indicators (KPIs) or Vital Signs, it will disappear into the whirlwind of activity that consumes your team’s day.
Rules of the Road
It is important for your team to know the rules of the road as it relates to a fostering union-free strategy. The playing field is not exactly even. Unions have the right to solicit employees and make promises of increased wages, benefits, and working conditions, regardless of their ability to deliver. However, employers are far more limited in what actions they can take regarding union representation. Employers can find themselves in trouble if they fail to follow some simple rules. Here are a few TIPS to help employers stay compliant.
T – Employers cannot Threaten to discipline or reduce wages and/or benefits if their employees unionize or engage in union activity;
I – Employers cannot Interrogate employees about their activities or feelings on union representation;
P – Employers may not make Promises to employees to improve wages, benefits, or working conditions if they remain union-free;
S – Employers cannot Spy on employees’ union-related activities.
Employers are free to discuss what joining a union might mean for the employee. For example, an employer can say “if the workforce is represented by a union, the terms and conditions of employment will be subject to collective bargaining. The collective bargaining process may result in employees getting more, getting less, or the same wages and benefits that they have now.” The key is, to be honest in all communications with your employees.
A Path Forward
EMS leaders should deliver a clear message to their frontline leadership team. Focus on developing strong relationships with their employees. Encourage open and frequent lines of communication, listen to employee concerns, and address them quickly. Ensure that frontline leaders have been provided training and the TIPS for maintaining a union-free work environment. Lastly, be sure to contact the AAA at email@example.com if you have questions or need assistance.
Proposed Changes to the OSHA Electronic Injury & Illness Reporting Requirements
The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) is proposing amendments to its occupational injury and illness recordkeeping regulation, 29 CFR 1904.41. The current regulation requires certain employers to electronically submit their summary injury and illness data (Form 300A) to OSHA annually. OSHA uses these reports to identify and respond to emerging hazards and makes aspects of the information publicly available.
In addition to reporting their Annual Summary of Work-Related Injuries and Illnesses, the proposed rule would require certain establishments in certain high-hazard industries to electronically submit additional information from their Log of Work-Related Injuries and Illnesses, as well as their Injury and Illness Incident Report (Form 300, 300A, & 301). The latest proposed rule will require certain employers to submit more detailed information and is a return to the original electronic data submission rule that was proposed in 2016 and rolled back in 2017, prior to the rule taking effect. EMS organizations will be included in those industries that are considered high-hazard and thus, required to submit this information.
As we reported last month, OSHA reported that there was a 249% increase in illnesses and injuries reported by healthcare employers in 2020. This is no surprise given that this was at the heart of the pandemic. OSHA believes this rule will improve the agency’s ability to use the information in its enforcement and compliance assistance efforts to identify workplaces where workers are at high risk.
The proposed rule would:
Under the proposed rule, establishments with 20-99 employees in certain high-hazard industries would continue to be required to electronically submit information from their OSHA Form 300A annual summary to OSHA annually.
Those interested can submit comments must do so by May 30, 2022. If you have questions about your organization’s reporting requirements under the OSHA Regulations, be sure to contact the AAA at firstname.lastname@example.org for assistance.
The United States Department of Labor (US DOL) has published a notice of intent to partially reopen the rule-making process to permit additional comment and a public hearing on certain aspects of the OSHA Emergency Temporary Standard for Healthcare employers which was originally published in June 2021. OSHA is seeking further input from stakeholders as they develop a final standard. The public hearing will begin on April 27, 2022.
The agency is reopening the rulemaking record to allow for new data and comments on topics, including the following:
OSHA made it clear that it is not proposing mandatory COVID-19 vaccination for healthcare workers. However, they are seeking comments regarding how it could help employers further support healthcare worker employees in their vaccination and boosting efforts. This could include paid leave, including travel time, for those seeking vaccinations or boosters.
The notice in the Federal Register had a slightly more relaxed tone as many areas in the country have seen a significant drop-off in cases. If you are interested in submitting comments, you can do so electronically at www.regulations.gov. If you wish to attend the video-based public hearing, you must file a notice of intention to appear with the US DOL within 14 days of the notice being officially published in the Federal Register.
If you have any questions about your current obligations under the OSHA rules, please email the AAA at email@example.com.
The 2022 Human Resources Toolkit includes the addition of numerous practice notes intended to provide EMS leaders with a more practical understanding of the legal principles that necessitate much of the language found in many of the sample policies in the HR Manual. Additionally, the practice notes provide suggestions for EMS agencies to better insulate the organization from legal liability.
On December 15, 2021, the United States Court of Appeals for the Fifth Circuit issued a ruling which modifies an earlier court national injunction related to the CMS mandatory vaccination rules. In the latest ruling, the court upheld the injunction issued by the United States District Court for the Eastern District of Missouri as it applied to the fourteen (14) plaintiff states, Louisiana, Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, West Virginia, Kentucky, and Ohio. However, it overturned the lower court’s expansion of that injunction to other, non-plaintiff states, in the injunction. Meaning that between the 5th and 8th Circuit Court rulings, the CMS mandatory vaccination injunction only applies to the following 24 states:
5th Circuit Plaintiffs: Louisiana, Montana, Arizona, Alabama, Georgia, Idaho, Indiana, Mississippi, Oklahoma, South Carolina, Utah, West Virginia, Kentucky, Ohio
8th Circuit Plaintiffs: Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire.
States not covered by the CMS mandatory vaccination injunction:
California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin
This decision, follows another mandatory vaccine related decision issued by the United States Court of Appeals for the Eleventh Circuit which criticized the Louisiana court for expanding the CMS vaccine mandate nationwide given that a Florida District Court had already refused to issue an injunction and because it felt that it was likely that the mandate was likely authorized under current CMS rules.
What does this mean for employers?
If you are an employer in one of the states not covered by an injunction, you should consult with any covered healthcare facility that your organization performs services under contract. These covered healthcare facilities will be required to mandate vaccination for their staff and for any contractor staff that interacts with their employees or patients. Additionally, they will be seeking proof that your staff is vaccinated against COVID-19, unless they have a protected medical or religious accommodation.
Employers should have already taken the initial steps toward compliance with the CMS mandatory vaccination rules, including having a list of all employees with their vaccination status. Additionally, employers should have an established policy related to mandatory vaccination and a procedure for requesting and processing an exception/accommodation requests. Lastly, healthcare institutions may independently institute mandatory vaccination rules for their employees and can require this of anyone entering their facility, including EMS staff.
We will continue to keep you post as these cases proceed through the legal system. These facilities may still independently require your staff to be vaccinated. If your organization has questions or need assistance deciphering or preparing for these requirements, please contact the AAA by emailing firstname.lastname@example.org.